The compendium is branded as the AO/OTA or OTA/AO Fracture and Dislocation Classification Compendium. Reports describing ORIF of tibial pilon fractures revealed a concerning complication rate with higher energy pilon fractures, including wound problems, deep infection, nonunion, and malunion (McFerran et al 1992, Teeny and Wiss 1993). What is the most appropriate Gustilo-Anderson classification of this injury? Ruedi-Allgower type 1 fractures are minimally displaced cleavage fractures, in contrast to type 2 injuries, which are displaced. When the fibula was intact, 58% of fractures were partial articular type B. 43B: partial articular fractures with some connection between part of the joint surface and the diaphysis - again, some series appear to include th… Pilon fractures, or fractures of the tibial plafond, range from low- to high-energy axial-loading injuries. Collectively, these 2 maps aid the surgeon in predicting necessary surgical tactics and approaches. "AO" is an initialism for the German "Arbeitsgemeinschaft für Osteosynthesefragen", the predecessor of the AO Foundation. Open fractures with vascular injury requiring repair along with extensive soft tissue compromise are considered type 3C. Sclerosis is due to impacted bone fragments/trabeculae. The AO long bone group universal classification of fractures groups distal tibia fractures as 43. He classifies ankle fractures according to the level of the fibular fracture. Volume 32: Number 1; Supplement, January 2018. The Müller AO Classification of fractures is a system for classifying bone fractures initially published in 1987 by the AO Foundation as a method of categorizing injuries according to therognosis of the patient's anatomical and functional outcome. 10.1055/b-0034-85578 2.2 Fracture classification Principles of Müller AO/OTA Classification of Fractures-Long Bones Describing fracture morphology Conclusion Classification terminology Further reading Author James Kellam 2.2 Fracture classification Fracture classifications have multiple purposes. According to the four-column classification scheme, lateral column of 85 cases, posterior column of 66 cases, medial column of 77 cases, and anterior column of 61 cases are involved. Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), Core Knowledge in Orthopaedics: Foot and Ankle. In publications, it will be cited as Meinberg E, Agel J, Roberts C, et al. Gustilo type 1 open fractures are generally clean with a < 1-cm skin laceration. Cole PA, Mehrle RK, Bhandari M, Zlowodzki M. The pilon map: fracture lines and comminution zones in OTA/AO type 43C3 pilon fractures. According to the Fernandez classification, 26 patients (76%) had type 5 fractures, and 8 patients (24%) had type 3 fractures. 2000 Jul-Aug. 8 (4):253-65. Principle 3: Metaphyseal bone defects are bone grafted to buttress the articular surface. Although the Arbeitsgemeinschaft für Osteosynthesefragen (AO)/Orthopaedic Trauma Association (OTA) classification system is the most widely accepted fracture classification system, the Ruedi-Allgower system is the classic fracture scheme often known and used for this injury throughout the world. "AO" is an initialism for the German "Arbeitsgemeinschaft für Osteosynthesefragen", the predecessor of the AO Foundation. Classification of distal tibial fractures AO Classification. These are considered to represent 1-10% of all lower limb fractures 6. There are also multiple small, comminuted fragments. Although the Arbeitsgemeinschaft für Osteosynthesefragen (AO)/Orthopaedic Trauma Association (OTA) classification system is the most widely accepted fracture classification system, the Ruedi-Allgower system is the classic fracture scheme often known and used for this injury throughout the world. Traction views may be valuable for further characterization of the pilon fracture. AO Trauma—Foot & Ankle ... Ankle trauma—pilon fractures. Currently the tibial pilon fractures are classified according to Ruedi Allgower and AO classification system , . J Orthop Trauma. Type 3 injuries portend the worst prognosis as a consequence of articular comminution and metaphyseal impaction. Initial splinting in the emergency room decreases further soft tissue trauma, and fracture dislocations should be reduced with adequate anesthesia to restore joint alignment. Small wire epiphyseal-diaphyseal ring fixators were then employed to treat pilon fractures to allow for early ankle motion in an effort to minimize long-term ankle stiffness. METHODS: One hundred and ten cases (107 patients) of Pilon fractures classified by the four-column theory and treated by ORIF, were reviewed. The quality of reduction with external fixation alone was suboptimal, leading to poor outcomes secondary to joint arthrosis. J Orthop Trauma. Spectrum of injuries: 1) Low energy rotational fx’s Ankle type fractures / Skiing, simple falls . Ruedi and Allgower described three groups based on the size and displacement of articular fragments: I - no comminution or displacement of joint fragments, II - some displacement but no comminution or impaction, III - comminution and/or impaction of the joint surface. Principle 1: Length and rotation is restored by ORIF of the fibula. The aim of this study was to evaluate the pitfalls and strategies of posterior column reduction in the treatment of complex tibial pilon fractures (AO/OTA 43-C3). Complications following surgical management of pilon fractures, particularly wound breakdown, were historically common. Select specialty. 1-10% of LE fx’s . Indications for closed reduction and cast treatment of pilon fractures are limited. The 2018 revision of the AO/OTA Fracture and Dislocation Classification Compendium for adults and children addresses the many suggestions to improve the application of the system, as well as add recently published and validated classifications. 1a-c). Pilon fractures treated with a cast have led to poorer outcomes than those managed operatively. Cole PA, Mehrle RK, Bhandari M, Zlowodzki M. The pilon map: fracture lines and comminution zones in OTA/AO type 43C3 pilon fractures. Limited ORIF to improve articular reductions without formal operative exposures was then employed to supplement external fixation strategies. six typical fragments, recognition of which helps plan reconstruction - not all present in any one patient: three main groups of fractures based on the main orientation of the fracture lines: coronal group, typically lower-energy fractures in older patients with a more distal metaphyseal-diaphyseal dissociation and valgus alignment (56%), sagittal group, typically higher-energy fractures in younger patients with a more proximal metaphyseal-diaphyseal dissociation and varus alignment (33%), comminuted fractures of such severity that they could not be assigned to any group (6%), a group of fractures ("lateral disruption fractures") with incongruity of the joint between the lateral malleolus and the lateral talar facet, often with an intact fibula. At the level of the ankle, the distal tibia is intimately associated with the fibula through strong ligamentous attachments. High-energy fractures are generally due to axial force that drives the talus into the tibial plafond, causing an “implosion” of the articular surface. C2 pilon fracture treated with the MIPO technique. The superficial peroneal and saphenous nerves are superficial to the fascia. Abstract Actually, pilon fractures are classified according to AO and Ruedi Allgower classification systems based on X-rays. Insert figures illustrating the classification. There simply is not a lot of soft tissue around the distal tibia, as compared to more proximal parts of the leg. Figures. Type A is extra-articular, type B is partially articular, and type C is completely articular. 19-year-old man ... Day 0. Two main classifications are used, which use different criteria for grouping. . In: OrthopaedicsOne - The Orthopaedic Knowledge Network. The AO classification, although comprehensive, is complicated and difficult to apply. In view of the fact that most pilon fractures usually occur as the result of violent trauma (i.e., motor vehicle accident), associated bodily injuries must be considered in the work-up of these patients. The series reported by Ruedi and Allgower described superior outcomes after formal open reduction and internal fixation (ORIF) in their patient population with few major complications. Code fractures and dislocations with the AO/OTA Fracture and Dislocation Classification 2018 for adults and pediatrics. They should facilitate communication among physicians and be useful for … . These classifications are less reproducible and do not provide necessary information for proper surgical planning. The pilon fracture usually has an anterolateral (Chaput) fragment and a posterolateral (Volkmann) fragment, which usually remain attached to the distal fibula segment by the anterior and posterior tibiofibular ligaments. Pilon fractures with extensive crush, degloving, or vascular injury are considered type 3. Primary fracture lines of 40 OTA-type 43C3 fractures are shown. After recovery from pilon fractures, many patients continue to have debilitating pain and ankle stiffness. Login. Once the swelling has peaked and regressed 1-3 weeks after injury, open reduction of the tibia (and fibula) can be performed with removal of the temporary external fixator. The classification system, broken into three categories focuses on the displacement and pattern of the fracture and the integrity of the coracoclavicular ligaments. Anterolateral exposures for pilon fractures risk injury to the superficial peroneal nerve. Initial external fixator constructs spanned the ankle joint until fracture union, resulting in unacceptable ankle stiffness. joint-spanning articulated vs. nonspanning hybrid ring. 3. A pilon fracture, is a fracture of the distal part of the tibia, involving its articular surface at the ankle joint.Pilon fractures are caused by rotational or axial forces, mostly as a result of falls from a height or motor vehicle accidents. The talus has the opposite geometry of the tibial plafond and therefore serves as a perfect template for assessing articular reduction of the distal tibia. Can be combined with subtypes of A or B. AO Spine Thoracolumbar Classification System Disclaimer: 1. Pilon is a French term used to describe a fracture of the distal tibia usually characterized by high-energy traits, including dissociation of the articular surface from the tibia shaft. The first sub-grouping is on the degree of cntinuity between diaphysis and metaphysis: 1. Recognition of a different category of higher energy pilon injuries emerged, which was quite different than those treated by Ruedi and Allgower, who treated lower energy injuries primarily in healthy skiers: So-called “boot top injuries.”. The systems used to classify the displaced distal pilon fractures are supposed to ensure the three-dimensional assessment of the fracture and provide high inter- and intra-observer agreement. These can be challenging to manage, especially when associated with significant soft-tissue injury. More recently, the AO/OTA classification of pilon fractures has been utilized. Leg compartment syndrome should be diagnosed based on clinical examination and confirmed if necessary with compartment pressures. Low-energy fractures typically occur due to rotational forces imparted to the distal tibia. 27(7):e152-6. A pilon fracture, is a fracture of the distal part of the tibia, involving its articular surface at the ankle joint.Pilon fractures are caused by rotational or axial forces, mostly as a result of falls from a height or motor vehicle accidents. Explanation. Fracture lines were mapped from axial CT cuts 3 mm above the plafond after an external fixator had been applied. The latest insights in diagnosis, classification and surgical treatment of tibia plateau and pilon fractures are reviewed. The Müller AO Classification of fractures is a system for classifying bone fractures initially published in 1987 by the AO Foundation as a method of categorizing injuries according to therognosis of the patient's anatomical and functional outcome. Type I: Intra-articular fracture of the distal tibia without significant displacement Type II: Intra-articular fracture of the distal tibia with significant displacement but minimal comminution Type III: Fracture of distal tibia with severe comminution and significant intra-articular displacement. The concave tibial plafond provides ~ 40% more posterior than anterior coverage. With this type of injury, the other bone in the lower leg, the fibula, is frequently broken as well. The rate of deep infection decreased with external fixation, however, at a cost. There are subtypes of each classification based on increasing complexity of the articular and metaphyseal components ( Fig. According to the AO/OTA classification, 17 patients had type B fracture and 14 patients type C fractures. A severely traumatized soft tissue envelope accompanies the higher energy pilon fractures. 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